Neurological outcomes after surgery for spinal metastases in symptomatic patients: Does the type of decompression play a role? A comparison between different strategies in a 10-year experience

Cofano, Fabio; Perna, Giuseppe Di; Alberti, Alessandro; Baldassarre, B.M.; Ajello, Marco; Marengo, Nicola; Tartara, Fulvio; Zenga, Francesco; Garbossa, Diego

doi:10.1016/j.jbo.2020.100340

Cited by 20 publications

(21 citation statements)

References 30 publications

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“…By contrast, we maintain that the primary focus of surgical management should be the preservation of neurological function and biomechanical stability rather than radical cytoreduction, thereby laying the foundation for adjunct therapy regimens that aim for oncological control. This may be achieved by tailoring the decompressive measures to the source of neural compression 36 . The separation technique and staged vertebral body replacement with anterior decompression are thus similar in concept, but different in execution.…”

Section: Discussionmentioning

confidence: 99%

Comprehensive surgical treatment strategy for spinal metastases

Wagner

Haag

Joerger

et al. 2021

Sci Rep

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The management of patients with spinal metastases (SM) requires a multidisciplinary team of specialists involved in oncological care. Surgical management has evolved significantly over the recent years, which warrants reevaluation of its role in the oncological treatment concept. Any patient with a SM was screened for study inclusion. We report baseline characteristics, surgical procedures, complication rates, functional status and outcome of a large consecutive cohort undergoing surgical treatment according to an algorithm. 667 patients underwent 989 surgeries with a mean age of 65 years (min/max 20–94) between 2007 and 2018. The primary cancers mostly originated from the prostate (21.7%), breast (15.9%) and lung (10.0%). Surgical treatment consisted of dorsoventral stabilization in 69.5%, decompression without instrumentation in 12.5% and kyphoplasty in 18.0%. Overall survival reached 18.4 months (95% CI 9.8–26.9) and the median KPS increased by 10 within hospital stay. Surgical management of SMs should generally represent the first step of a conclusive treatment algorithm. The need to preserve long-term symptom control and biomechanical stability requires a surgical strategy currently not supported by level I evidence.

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Section: Discussionmentioning

confidence: 99%

Comprehensive surgical treatment strategy for spinal metastases

Wagner

Haag

Joerger

et al. 2021

Sci Rep

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“…Although there is no specific management algorithm for the treatment of vertebral metastases from SDCs, those with single osteolytic lesions and high-grade epidural compression may be successfully treated with aggressive gross-total surgical resection followed by radiation therapy. [ 1 , 3 - 6 , 8 , 9 , 13 ] Due to the frequency of SCD’s invasion and their aggressive nature, surgical treatment should include a radical/ total parotidectomy with sacrifice of the facial nerve and ipsilateral lymph node dissection, followed by postoperative chemotherapy/radiotherapy. Even with such aggressive management, there is a nearly 65% locoregional rate of metastatic relapse, and patients typically succumb from recurrent and/or progressive disease within 48 months.…”

Section: Discussionmentioning

confidence: 99%

Solitary late spinal metastasis from apocrine salivary duct carcinoma: Case report

Baldassarre

Penner

Bertero

et al. 2021

Surgical Neurology International

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Background: The salivary duct carcinomas (SDCs) are rare, high-grade neoplasms involving major salivary glands. Parotid is the most frequently involved gland (85%). Apocrine phenotype (histological presence of decapitation secretions) and androgen reception expression define SDC. The clinical course of these tumors is characterized by aggressive local behavior with extraglandular extension, high recurrence rates, early metastases, and poor prognoses. Despite aggressive surgical/radiation therapy management, the rates of locoregional and metastatic relapses are high, and the mortality rates over 48 months approach 65%. Notably, there is no treatment algorithm available for managing vertebral metastases from apocrine SDC. Case Description: An elderly male presented with MR/CT findings of an isolated T11 vertebral metastasis attributed to a previously treated parotid SDC. On both CT/MR, it was an osteolytic lesion and demonstrated spinal canal infiltration. The patient underwent surgical biopsy/decompression/resection, following which the lesion histopathologically proved to be a SDC. The patient was subsequently treated with 30 Gy in 10 fractions within 2 weeks of discharge. One-month later, the MRI confirmed adequate epidural decompression without recurrence, and 9 months post-operatively, patient remained disease free. Conclusion: Isolated metastasis attributed to parotid SDC followed by radiation therapy may result in tumor control.

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“…Other than preoperative AIS grades, ambulatory status before surgery, the time of developing motor deficits and the quality of decompression also affected the ambulatory recovery. 11 , 21 , 22…”

Section: Discussionmentioning

confidence: 99%

Effect of the Timing of Surgery on Neurological Recovery for Patients with Incomplete Paraplegia Caused by Metastatic Spinal Cord Compression

Cui¹,

Shi²,

Li³

et al. 2021

TCRM

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Objective This study aimed to investigate the effect of timing of surgery on neurological recovery for patients with metastatic spinal cord compression (MSCC). Methods According to the timing of surgery, 75 patients with incomplete paraplegia caused by MSCC were assigned to 3 groups: within 3 days (group A), between 4 days and 7 days (group B), and after 7 days (group C). T -test, one-way ANOVA, Mann–Whitney U -test, and Chi-square test were used to evaluate the difference in the improvement of American Spinal Injury Association Impairment Scale (AIS) and ambulatory status, the incidence of perioperative complications, surgical site infection, and the length of hospital stay between 3 groups. Results Patients with incomplete paraplegia treated in our department had an average of 17.4±1.8 days delayed and most occurred before hospitalization (4.0±0.4 vs 13.2±1.8, P<0.001). There was no significant difference in the AIS improvement between patients with different pre-op AIS. The timing of surgery was significantly correlated with AIS improvement (correlation coefficient=−0.257, P=0.019). Sub-analysis showed that patients who underwent surgery within 7 days (group A and group B) had significantly better AIS improvement compared with group C (improved at least 1 grade, P=0.043; improved more than 1 grade, P=0.039) and the surgery timing was more important for patients with AIS B and C. The timing of surgery was significantly correlated with the length of hospital stay (correlation coefficient=0.335, P=0.003). Patients of group C had the longest length of hospital stay (P=0.002). The incidence of perioperative complications and surgical site infection did not differ significantly between the 3 groups. Conclusion Delay surgery was common in incomplete paraplegia patients with MSCC. Patients with AIS B and C who underwent surgery within 7 days had better AIS improvement.

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Neurological outcomes after surgery for spinal metastases in symptomatic patients: Does the type of decompression play a role? A comparison between different strategies in a 10-year experience

Cited by 20 publications

References 30 publications

Comprehensive surgical treatment strategy for spinal metastases

Comprehensive surgical treatment strategy for spinal metastases

Solitary late spinal metastasis from apocrine salivary duct carcinoma: Case report

Effect of the Timing of Surgery on Neurological Recovery for Patients with Incomplete Paraplegia Caused by Metastatic Spinal Cord Compression

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